opinion : lowered residency work hours makes better physicians

A recent discussion with an attending highlighted an important generational gap in academic medicine, one that has become much more pronounced with the changing resident work hour requirements. The issue is that older doctors feel that the end-all of learning as a student and a resident is achieved by maximizing the hours spent in the supervised clinical setting (“on call”). Most younger doctors tend to avoid these on-call hours, which the older attendings often believe is because of laziness or lack of dedication to medicine. This is a misconception that needs to be corrected however. Young doctors do not like structured clinical on-call hours because we recognize that they are sub optimal for learning.

The first reason that traditional on-call hours are sub optimal for learning has to do with what is expected of doctors during those hours. Most of the work done during these hours is “scut” work, both patient and institutional paperwork that had nothing to education. The second and more important reason however is that people in my generation who have grown up with computers and online resources have come to realize that self-directed, active learning is by far the most effective means to learn the vast quantity of data required to be a competent physician.” Back in the day”, the only way to get information from a good medical lecture was to sit physically in the room and listen to that person talk(some hospitals had physical tape recordings?). Today almost all lectures from any medical school are available to be instantly streamed on the Internet. Throughout medical school, most students have learned to maximize their study time by using their personal preferred online resources. While current residents often spend 100 hours per week learning medicine just as their predecessors did, we understand that is much more effective to have less time with direct patient care and more time in front of our computers studying in the areas that we are weakest on. While this does not necessarily apply to procedure oriented specialties such as surgery, information oriented specialties such as medicine and radiology clearly benefit from residents having extra time when they're not on duty to study as they see fit. In this light, it is easy to see that a resident who spends 80 hours on call and 20 hours studying on their own time is going to be a more knowledgeable resident and one who spends 100 hours on call faxing pharmacy requests and rewriting safety checks. There was a time when the only way to see rare cases was to be on call when these cases came to the hospital, but instant access to electronic resources has made this an issue of the past, especially in radiology.

The idea that you can be a better resident in less time is hard to understand to someone who grew up in an era where commitment and quality were measured by number of cases seen and amount of time put in. It is difficult for many old-timers understand that you can be a better doctor by putting in less time as long as that extra time is used correctly. Young doctors can in fact be better trained in fewer hours.